Suspended head of Gauteng health Barney Selebano terminated the contract with Life Esidimeni, despite warnings from internal medical experts about the impact of moving mentally ill patients.
This emerged during the Life Esidimeni arbitration hearing Johannesburg on Tuesday.
In an email, the experts warned of the "devastating impact" it would have, adding that a similar move failed when several patients died after a group of 40 were transferred from Life Esidimeni in 2009.
Concerned experts also warned of the need for the gradual and individualised discharge of mentally ill patients from Life Esidimeni, as opposed to a mass move, and further indicated that the move would have the opposite effect of cost-cutting.
The email was sent to suspended head of mental health, Dr Makgabo Manamela, and Selebano was copied in it in April 2015.
Despite this, Selebano said that the department made a collective decision to go ahead with the plan after it was presented to him by Manamela and her team.
Selebano signed the termination of the contract between Life Esidimeni and the health department in September 2015, and patients were crammed into non-governmental organisations (NGOs) and facilities that were not fit for the purpose of looking after their needs.
The disgraced former head contended that he could not recall seeing the email, but said he would not have given his approval in light of its contents.
One of the reasons the department took the decision was because it was under immense fiscal strain.
"[The department] has serious pressures because of the little resources that they have and they are under pressure to provide services, and the Treasury then would advise with the [heads of department] to find ways of getting the same value but... using less resources and at a less cost," a nervous-looking Selebano said.
He blamed Manamela and former health MEC Qedani Mahlangu, who he said pressured him to move the patients quickly.
The cost-cutting project led to the death of over 140 mentally ill patients. Over 50 are still currently missing.
He testified that he heard of the deaths around mid-July 2016 through opposition party, Democratic Alliance (DA), and the media, but at the time, he said he only knew of 36 deaths.
Selebano, a subpoenaed witness, told the panel that he closed down NGOs and told others to move patients to safer places as soon as he was pressured by health minister Aaron Motsoeledi, who told him that he did not want any more deaths.
"We, [along with the department], moved the patients because there was a situation where there were a lot of deaths, and we could not have any more deaths at the NGOs," he said.
Selebano admitted that, in hindsight, the rushed plan was not to the benefit of the vulnerable patients, saying that things should have been done differently. He said many NGOs took on more patients than they could handle and treat, in an effort to get more subsidies.
Before his testimony, Selebano's legal representative Arthur Cook argued that he did not believe that his client had anything important to contribute, hinting that he did not want to self-incriminate.
Selebano has tried to avoid appearing at the arbitration, attempting twice to legally weasel his way out of testifying.
His application to the South Gauteng High Court was dismissed on Monday as well as his application for leave to appeal. He was attempting to challenge a subpoena forcing him to give evidence on what happened.